NPIMap

Individual provider Active NPI

Loren Mangino, M.D.

  • Family Medicine Physician
  • Forty Fort, PA
National Provider Identifier
1851730550
Registry record updated Nov 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD458971 Issued in PA
Practice address
920 Wyoming Ave Ste 103
Forty Fort, PA 18704-3971
Phone
(570) 714-7500
Fax
(570) 714-2710
NPI assigned
Jun 17, 2013
Last updated
Nov 30, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD458971 PA Primary

Addresses

Primary practice location

920 Wyoming Ave Ste 103
Forty Fort, PA 18704-3971

Mailing address

610 Wyoming Ave
Kingston, PA 18704-3702

Other identifiers 1

IdentifierTypeStateIssuer
1031523210002MedicaidPA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address loren.mangino.2@21771.direct.athenahealth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161004000274 PA Practitioner - Family Practice 1254562309 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Commonwealth Physician Network LLCGroup PAC ID 2668696592, 63 clinicians

Practice addresses (Care Compare)

4 E Main St
Nanticoke, PA 18634-1602
Phone (570) 735-7474

920 Wyoming Ave
Suite 103
Forty Fort, PA 18704-3971
Phone (570) 714-7500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.17 of 100Reported as apm
Quality
78.34
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy11

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD458971PAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Commonwealth Physician Network LLC Family Medicine CurrentSince Nov 15, 2023 Accepting new patients
Berwick Clinic Company LLC Family Medicine CurrentSince Dec 1, 2019 Accepting new patients
Kingston SNF Healthcare, LLC Past Accepting new patients

Locations

751 E 16th St
Ste 400
Berwick, PA 18603
Phone (570) 759-5555

920 Wyoming Ave
Ste 103
Forty Fort, PA 18704
Phone (570) 714-7500

610 Wyoming Ave
Kingston, PA 18704
Phone (570) 288-5441

610 Wyoming Ave
#2
Kingston, PA 18704
Phone (570) 714-1032

4 E Main St
Nanticoke, PA 18634
Phone (570) 258-3939

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1704/brand/1/csg/81/fhir/r4
  • Direct secure messaging: loren.mangino.2@21771.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Third Avenue Health & Rehab CenterKingston, PA, CCN 395905 Skilled nursing facility Adp of the SNF Jun 24, 2024

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 73

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 73

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1371427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638230400000",
    "number": "1851730550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 WYOMING AVE",
            "city": "KINGSTON",
            "state": "PA",
            "postal_code": "187043702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 WYOMING AVE STE 103",
            "city": "FORTY FORT",
            "state": "PA",
            "postal_code": "187043971",
            "telephone_number": "570-714-7500",
            "fax_number": "570-714-2710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGINO",
        "first_name": "LOREN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-17",
        "last_updated": "2021-11-30",
        "certification_date": "2021-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD458971",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1031523210002",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "loren.mangino.2@21771.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR Direct Address",
            "address_1": "920 Wyoming Ave Ste 103",
            "city": "Forty Fort",
            "state": "PA",
            "country_code": "US",
            "postal_code": "187043971",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Forty Fort, PA

Sources for this page

Verify at the official NPI Registry.